GASTRO Flashcards
Gold standard for coeliac diagnosis
Who is referred for this
Biopsy
Jej or duodenum
Looks for villous atrophy. Also get lymphocyte infiltration
Referred if +ve TTG
Most common extra intestinal feature of crohns and UC
arthritis
What age group get Achalasia and what would make you think of it
Middle age
Difficulty swallowing liquid and food
What would birds beak appearance indicate
Barium swallow - achalasia
Adverse effects of Aminosalicylates
Agranulocytosis so need FBC.
If they’re allergic to aspirin they might also react to this.
Mesalazine carries 7x risk of pancreatitis
SulFAsalazine - fibrosis, anaemia (Heinz body), oligospermia,
How to tell duodenal vs gastric ulcers on symptoms.
The pain associated with duodenal ulcers improves after meals
Pain associated with gastric ulcers generally intensifies after meals.
Who does primary biliary cholangitis commonly affect
How does it commonly present
What was it previously called
Middle aged women
Itching in a middle aged woman
Previously primary biliary cirrhosis.
Can get jaundice and xanthomas
What part of body is affected in primary biliary cholangitis and how
Interlobular bile ducts become damaged by a chronic inflammatory process ->cholestasis -> cirrhosis.
What condition is associated with primary biliary cholangitis
Sjogrens
What investigations to do for primary biliary cholangitis
anti-mitochondrial antibodies (AMA) M2 subtype present in 98%
smooth muscle antibodies in 30% of patients
raised serum IgM
Management primary biliary cholangitis
first-line: ursodeoxycholic acid
slows disease progression and improves symptoms
pruritus: cholestyramine
fat-soluble vitamin supplementation
liver transplantation
e.g. if bilirubin > 100 (PBC is a major indication)
Primary sclerosis cholangitis - what part of body is affected
inflammation and fibrosis of intra and extra-hepatic bile ducts.
What disease is PSC associated with
UC
How to investigate PSC and what might you see
MRCP/ERCP - beaded appearance (due to strictures)
Also p anca
Complications of PSC
cholangiocarcinoma (in 10%)
increased risk of colorectal cancer
Complications of PBC
HCC
How to induce remission in Crohns
Steroids 1st line
2nd line mesalazine
Azathioprine or mercaptopurine can be used as an adjunct but not monotherapy
How to maintain remission in Crohns
Azathioprine or mercaptopurine
How to treat and investigate perianal fistulae in crohns
MRI
Metronidazole
How to treat proctitis in UC
Rectal aminosalicyclates.
If no result after 4 weeks add an oral one
If still no result add topical/ oral steroid
How to treat proctosigmoiditis and left-sided ulcerative colitis
- Rectal aminosalicyclate
- Either add oral aminosalicyclate OR oral aminosalicyclate and topical steroid
3rd line. oral steroids/ oral aminosalicyclates only
How to treat extensive UC
- Topical aminosalicyclate plus a high dose oral one
- If after 4 weeks no result stop topical and add oral steroids
How to maintain remission in UC
Proctitis or proctosigmoiditis: oral or topical aminosalicyclates
If bad then oral aminosalicyclate
When would you use azathioprine or mercaptopurine in UC?
Following a severe relapse or >=2 exacerbations in the past year
how to monitor treatment in haemochromatosis
Ferritin and transferrin saturation
Who gets prophylaxis for SBP
what is used
Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin
What would an alcoholics AST:ALT ratio be like?
AST:ALT greater than 2
(salt before lime in tequila)
What would NAFLD AST and ALT ratios look like?
ALT:AST ratio >2.
How to tell whether LFTs Hepatitic or biliary probs
Hepatitic - raised ALT more than ALP
Biliary - Raised ALP.
How can you tell if someone is having crohns flare (single best ix?)
Fecal calprotectin
What can thiopurines increase risk of
Non melanoma skin ca
What do you see in Gilberts
Increase in unconjugated bili
Causes a pre hepatic jaundice picture.
How would you differentiate Gilberts from other causes of pre-hepatic jaundice?
No anaemia in Gilberts
What is Budd Chiari syndrome?
Symptoms?
What would you see on MRI?
When you get obstruction to hepatic venous outflow.
Hepatomegaly, ascites, abdo pain.
Prominent caudate lobe.
